EAST GEORGIA HMA PHYSICIAN MANAGEMENT, LLC - NPI NUMBER 1487983151

Summary

Provider Name: EAST GEORGIA HMA PHYSICIAN MANAGEMENT, LLC

NPI Number: 1487983151

Clasification: Psychiatry & Neurology (2084N0400X)

Specialization: Neurology

Address:
1497 FAIR RD
STATESBORO, GA
ZIP 30458

Phone Number: (912) 486-1626



Detailed Information

EAST GEORGIA HMA PHYSICIAN MANAGEMENT, LLC is a neurologist in Statesboro, GA. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. The assigned NPI number for this provider is 1487983151 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

1497 FAIR RD
STATESBORO, GA
ZIP 30458-822
Phone: (912) 486-1626

The provider's authorized official is Michael L Gingras .
The authorized official title is Vice President and has the following contact phone number (239) 598-3131.

The enumeration date for this NPI number is 12/9/2009 and was last updated on 11/26/2012.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1013131598 ROBERT WAYNE MOONEY, MD
Psychiatry & Neurology (Addiction Medicine)
1083830400 STATESBORO PSYCHIATRIC ASSOCIATES
Psychiatry & Neurology (Psychiatry)
1225201494 ANDREW V CICHELLI MD INC
Psychiatry & Neurology (Sleep Medicine)
1184737728 THE NEUROLOGICAL CENTER OF EAST GEORGIA PC
Psychiatry & Neurology (Neurology)
1700947231 KASHYAP PATEL, M.D.
Psychiatry & Neurology (Neurology)
1700901980 MICHAEL STEPHEN LICHTMAN, MD
Psychiatry & Neurology (Psychiatry)
1629257787 DR. MICHAEL ANTHONY TAORMINA, M.D.
Psychiatry & Neurology (Neurology)

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 2084N0400X Psychiatry & Neurology Neurology No
2 207RC0000X Internal Medicine Cardiovascular Disease Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 202G703431 MEDICARE PIN GA

NPI Record

No. Field Name Field Value
1 NPI 1487983151
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name EAST GEORGIA HMA PHYSICIAN MANAGEMENT, LLC
5 Provider First Line Business Practice Location Address 1497 FAIR RD
6 Provider Business Practice Location Address City Name STATESBORO
7 Provider Business Practice Location Address State Name GA
8 Provider Business Practice Location Address Postal Code 304580822
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 9124861626
11 Provider Enumeration Date 12/9/2009
12 Last Update Date 11/26/2012
13 Authorized Official Last Name GINGRAS
14 Authorized Official First Name MICHAEL
15 Authorized Official Middle Name L
16 Authorized Official Title or Position VICE PRESIDENT
17 Authorized Official Telephone Number 2395983131
18 Healthcare Provider Taxonomy Code 1 2084N0400X
19 Healthcare Provider Primary Taxonomy Switch 1 N
20 Healthcare Provider Taxonomy Code 2 207RC0000X
21 Healthcare Provider Primary Taxonomy Switch 2 Y
22 Other Provider Identifier 1 202G703431
23 Other Provider Identifier Type Code 1 08
24 Other Provider Identifier State 1 GA
25 Is Organization Subpart Y
26 Parent Organization LBN HEALTH MANAGEMENT ASSOCIATES, INC
27 Parent Organization TIN
28 Authorized Official Name Prefix Text MR.
29 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP
30 Healthcare Provider Taxonomy Group 2 193200000X MULTI-SPECIALTY GROUP

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.